SPECIAL REPORT
The Bitterest Pill
Swallow this: With 70 percent unable to afford the rising cost of medicines, Filipinos are crossing their fingers to get cured
By Jomike del Rosario
In 1988, the Philippines was one of the first countries in Asia to pass a law on generic drugs. This law allowed for the local production of generic drugs, which was meant to broaden access to medicines, as well as lower their prices. But 19 years later, the Philippines has some of the highest prices of drugs in the region, second only to Japan. As a result, almost three-quarters of our population cannot afford the drugs they need to get and stay healthy.
Why we can't follow doctor's orders
It's no wonder that in the World Bank's study, On Improving the Poor's Access to Affordable Drugs, the use of medicines has been described as ‘inadequate' and ‘irrational.' The lack of purchasing power and access to health care compromises the health of the poor, who resort to self-medication and worse, no treatment at all.
"Dati, ang term, noncompliance," relates Gene Alzona Nisperos, MD, secretary general of the Health Alliance for Democracy (HEAD). "Yung noncompliance kasi, reresitahan ka, ‘O, bili ka ng 28 na piraso nito.' Ang bibilhin mo lang, 10. Pag gumaling ka okey na, kasi nakatipid ka. Ngayon, non-adherence na. Gusto niya talagang mag-comply, pero hindi niya kaya dahil mahal."
It remains to be asked: Why the faint-inducing sticker price? Overpricing or price-fixing–from the drug makers all the way to the drug stores–is the culprit. This is according to Angelito Mendoza, co-convenor of the Ayos na Gamot sa Abot-kayang Presyo Coalition (AGAP). "I say overpricing because they are priced something like 300 percent more [and upwards]," Mendoza laments.
From ownership of the patents on medicines down to retail sales for us consumers, it is not too hard to get an idea of what the sickly Filipino is facing: big businesses. Monopolies even, as suggested by the World Bank. How did such a situation come about? One answer lies in patents protected by the Intellectual Property Code of the Philippines.
"A patent in itself is a monopoly," Dr. Nisperos says. "In recognition of the pharmaceutical company's efforts, they give them a monopoly [on that medicine]." He adds that due to the stunted national drug industry, competition cannot drive down the prices. "Dito, walang kumpitensya. So they can actually dictate the price of a drug and base it on what the market can bear. Ang pricing nila, hindi based on cost of production."
One specific drug that has raised eyebrows is amlodipine besylate, used for hypertension. With each 10-mg tablet costing nearly P75, and the same drug costing between P8.96-P45.65 in other countries, AGAP cried foul. Amlodipine takers—and there are a lot of them; 409 of every 100,000 Filipinos had been prescribed the drug at the time–were being burdened unnecessarily by ‘big pharma.'
The price of amlodipine was cut by 50 percent in response to nongovernment groups like AGAP, says Mendoza. The drug trader offers discount cards dispensed by doctors at their own discretion so the patients can avail of the markdown. Not a bad response from the company, right? Not so according to Mendoza.
"That's proof," he says. "We're making a dent and have also established the veracity of our claim that they are overpricing."
Dr. Nisperos agrees: "If they can give a 50 percent discount, that means they're still making a profit even at half the price. So meron talagang parang unethical profit-taking."
"A decrease in price only answers one aspect of health care, which is affordability," says Catherine Ileto, who manages the corporate affairs of Pfizer Philippines. "[Amlodipine] is appropriately priced in the Philippines given the market condition and its value to patients."
It takes an average of 15 years for a single medicine to go into production with the cost of research and development ranging from US $800 million to one billion, adds Ileto.
Comparing Countries
It's no secret that India has some of the lowest prices of medicines in Asia. For example, an antibiotic that costs P5.10 per tablet in India would cost P28.75 here. In practical terms, a guy in India could fill his prescription for 14 pills for only P71.40; whereas a Flilipino man who needed the same drug would owe P86.25 for just three of the 14 pills he was prescribed. Even among our neighbors like Malaysia or Thailand, we still pay significantly more to nurse ourselves back to health.
In fairness, it's difficult to compare the Philippines' to India's pharmaceutical industry. First, India's government did not recognize intellectual property rights (IPR) on substances, so they produce medicines without paying royalties, according to Nisperos. Secondly, their government invested huge sums of money for companies to create drug factories. This created the competitive market absent in the Philippines. As of 2002, the country only has 80 producers of pharmaceuticals. India has approximately 30,000 drug companies, according to Ileto.
Think of it in economic terms: The more competition there is in the market, the lower the prices get. Imagine India as a typical cellphone tiangge, only with brightly colored pills for different diseases and you get the picture. The roles are reversed. The sellers are the ones eagerly hawking their wares, lowering their prices so you buy from them. In our case, competition is scarce, so prices remain in the stratosphere.
» Health archive
Men's Health Philippines - May 2007 Issue
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Consider these facts about our local pharmaceutical industry:
Of the estimated P92 billion drugs sold in the country, 88 percent are brand-name products.
Unbranded generics account for about four percent of the pie.
The local drug market is 95 percent dominated by multinational and transnational companies (MNCs and TNCs). Unilab the largest Filipino company and the market leader, has expanded operations in Southeast Asia.
So although the government may have had good intentions, the 1988 law clearly didn’t do what it was supposed to do: get cheaper drugs into the hands of those who need them. What went wrong?
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